Abstract library

Introduction: Nesidioblastosis is an uncommon cause of persistent hyperinsulinemic hypoglycemia (PHH) in adults. Although it is well-described in infants, the pathophysiology in adults is poorly understood.

Introduction: The control of hypoglycemic hyperinsulinemic syndrome from malignant insulinoma is challenging because it is often refractory to diazoxide and somatostatin analogues (SA). Everolimus can have side effects that can limit its use. Pasireotide, a multi-receptor-targeted SA with a high binding affinity to SSTR1 and SSTR5, exhibits a strong inhibitory effect of insulin secretion.

Introduction: A pancreatic neuroendocrine carcinoma with liver metastases was diagnosed on July 2006 in a 65-year-old man. He was treated with octreotide LAR 30 mg for three years. At liver progression he was enrolled in a multicenter Italian trial titled “XELBEVOCT” with Bevacizumab + Metronomic Capecitabine + Octreotide LAR 30 mg. After seven months, the patient exhibited severe hypoglycemic syndrome with HGT serum levels<30 mg/dl, insulin 150 microUI/ml, and C-peptide at upper normal limits. Endocrinologist prescribed prednisone, diazoxide and recombinant glucagon for hypoglicemic crisis, with little benefit. In March 2010, the patient was given radio-labelled Lu-177-OCTREOTATE treatment. After three cycles, hypoglicemic symptoms were still uncontrolled. CT scan showed stable disease.

Introduction: The key clinical problem in patients with islet cell tumors are persistent hypoglycemia episodes, which are particularly dangerous in the elderly since neuroglycopenia may be the cause of stroke.

Introduction: Biochemical diagnosis of endogenous hyperinsulinemic hypoglycemia is straightforward. Surgical removal of an insulinoma is hampered by difficulties to localize it using conventional radiological procedures. In vitro data suggest that human insulinoma cells exhibit a high density of GLP-1R. 111In-exendin-4 is an 111In labeled GLP-1R agonist that binds with high affinity to GLP-1R and may be helpful in localizing insulinomas.

Introduction: SPECT/CT imaging with GLP1-R specific radiotracers like 111In-DOTA-exendin-4 have already proved to be a useful tool for the preoperative localisation of insulinomas. PET/CT has several advantages over SPECT/CT: lower radiation exposure, less time consumption and higher spatial resolution.

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